Impaired Cardiovagal Activity as a Link Between Hyperglycemia and Arterial Stiffness in Adults With Type 2 Diabetes Mellitus Among an Eastern Indian Population: A Cross-sectional Study.

OBJECTIVES: Cardiac autonomic neuropathy (CAN) is one of the most common yet overlooked complications of type 2 diabetes mellitus (T2DM). Individuals with T2DM with CAN have a 5-fold higher rate of cardiovascular morbidity and mortality. The presence of CAN in T2DM could potentially lead to arterial stiffness. However, only sparse data are available suggesting any association between autonomic dysfunction and arterial stiffness in T2DM. METHODS: We recruited 80 people with T2DM and 74 healthy controls for our study. Heart rate variability (HRV) testing was performed to assess autonomic function. Assessment of arterial stiffness was done by measuring the brachial pulse wave velocity (baPWV) and augmentation index (AI). RESULTS: The time-domain parameters were significantly decreased (p<0.001) and frequency-domain parameters, such as total power and high-frequency band expressed as a normalized unit, were found to be significantly reduced in people with T2DM (p<0.001). Both baPWV and AI were significantly higher in people with T2DM compared with healthy controls (p<0.001). We observed a moderate correlation between standard deviation of normal to normal interval (SDNN) and baPWV (r=-0.437, p=0.002) and AI (r=-0.403, p=0.002). A multiple linear regression model showed an association between SDNN and arterial stiffness parameters, such as baPWV and AI, which were statistically significant (p<0.05) in a fully adjusted model that included the conventional risk factors for atherosclerosis. CONCLUSIONS: Impaired cardiovagal activity is an independent risk factor for the development of arterial stiffness. Incorporation of HRV testing into the diabetes management protocol would have potential benefits for identifying individuals at high risk of developing cardiovascular events. Hence, preventive measures can be taken as early as possible to improve patient outcomes.

Association of Atherogenic Index of Plasma With Retinopathy and Nephropathy in Adult Patients With Type 2 Diabetes Mellitus Aged > 18 Years.

OBJECTIVES: In this study we assessed the atherogenic index of plasma (AIP) in relation to retinopathy and nephropathy in patients with type 2 diabetes mellitus (T2DM). METHODS: In this cross-sectional study there were 4,358 inpatients with T2DM. The patients were divided into 4 groups: T2DM without complications (DM group), T2DM complicated with retinopathy alone and nephropathy alone (DR-alone and DN-alone groups) and T2DM complicated with both DR and DN (DRN group). AIP was calculated by the formula of log [triglyceride / high-density lipoprotein cholesterol]. RESULTS: AIPs in the DR-alone, DN-alone and DRN groups were significantly higher than in the DM group, with the DRN group having the highest AIP level. Moreover, patients with proliferative DR had higher AIPs than patients with nonproliferative DR in the DR-alone and DRN groups, and patients with macroalbuminuria had higher AIPs than patients with microalbuminuria in DN-alone and DRN groups. The highest AIP quartile group had the highest proportion of DRN compared with the other quartile groups. The DRN group had a maximal area under the curve (AUC) for AIP on receiver operating characteristic curve analysis (AUC=0.735). In the subgroup analyses by age, the AUCs of patients <65 years of age were all greater than those of patients ≥65 years of age. Logistic regression analysis showed that AIP had the highest correlation with age <65 years in individuals with DRN, and this association remained significant after adjustment with 3 models. CONCLUSIONS: AIP is positively associated with both occurrence and severity of diabetic microvascular complications. It can predict their presence in T2DM, especially in those <65 years of age with DRN.

La relación entre el biomarcador índice digital D2:D4 y el diagnóstico psicopedagógico de TDAH. Datos de un estudio / The relationship between the biomarker ratio D2:D4 and the psycho-pedagogical diagnosis of ADHD. Data from a study

Resumen La hipótesis organizacional sostiene que el índice digital D2:D4 (obtenido de la división entre la longitud de los dedos índice y anular) es un biomarcador que informa de la sobreexposición a la testosterona a nivel prenatal (Myers et al., 2018). El objetivo del presente trabajo fue determinar si el índice digital podría ser útil en el diagnóstico psicopedagógico del trastorno por déficit de atención con hiperactividad (TDAH), dado que los trabajos previos no son concluyentes en este punto (Stevenson et al., 2007; Wang et al., 2017). La muestra estudiada estuvo conformada por 82 estudiantes de ambos sexos (Medad = 11.77 años, DE = 2.97) de la región de Andalucía (España), igualada en edad, sexo y nivel cognitivo. La mitad de los participantes tenía diagnóstico de TDAH, la otra mitad, no. Los resultados reflejan menor índice digital en participantes del grupo con diagnóstico de TDAH (.945) versus el grupo control (.995), y estas diferencias son significativas (p = .000), independientemente del sexo. Además, la presencia de determinados comportamientos en el entorno doméstico (medidos con la Escala Conners) correlaciona positivamente con un bajo valor del índice digital (r = .47; p = .001) y con el diagnóstico psicopedagógico de TDAH.

Abstract The digital ratio D2:D4 (length of the index finger between the length of the ring finger) is a biomarker that reports the presence of high levels of testosterone during the prenatal period. A differential digital pattern (D2 < D4) has been found in several disorders (ASD or Klinefelter's syndrome) although data for Attention Deficit Hyperactivity Disorder (ADHD) are not conclusive (Stevenson et al., 2007; Wang et al., 2017). The aim of this paper was to determine whether digital ratio can be used as an indicator in the psychoeducational diagnosis of ADHD. A sample of 82 students of both sexes aged between 6 and 16 years (M = 11.77, SD = 2.97) from the Andalusian Community was taken. Among the members of the sample there were no differences in terms of sex, age, or cognitive level. The sample was divided into two groups, the group with a psycho-pedagogical diagnosis of ADHD and the control or undiagnosed group. The group with ADHD consisted of 42 subjects and the control group consisted of 46 subjects. All sessions were conducted individually for each of the subjects and their families following these guidelines: the session began with the parent signing a consent form that allowed the therapist to proceed with the intervention. After that, the TONI-2 non-verbal intelligence test was given to the child by the therapist in a quiet room. At the same time, the parents responded to the Conners Scale questions on behaviour at home to verify the existence or not of behavioural symptoms compatible with the presence of ADHD. For parents of children with ADHD diagnosis, an interview was conducted to learn about the course of the disease to have a general profile of the patient and his or her disorder. Finally, the participants' right hand was scanned at the same school with an HP DeskJet 2630 scanner printer. Using the scanner and the Adobe Photoshop® tool, the length of the index and ring fingers was measured [(from proximal line of the finger to the end of the distal phalanx of the index (D2) and ring (D4) fingers]. The digital measurements from the scanned images were taken by the two researchers who signed the work, and there was more than 90 % agreement on the measurements. The results show a lower digital index in participants in the ADHD group (.945) versus the control group (.995), these differences being significant (p = 0.000), regardless of gender. In addition, the presence of certain behaviours in the home environment (measured with the Conners Scale) correlates positively with a low value of the digital index (r = .47; p = .001) and with the psycho-pedagogical diagnosis of ADHD. Significant differences have been shown in this study. Subjects with a psychopedagogical diagnosis of ADHD have been exposed to higher levels of testosterone during pregnancy since they present a lower D2:D4 ratio compared to the participants in the control group (without a diagnosis of ADHD), in line with the work of Martel et al. (2008) and Wang et al. (2017). In addition, this study has found that the group with psychopedagogical diagnosis of ADHD has a shorter index finger than the ring finger in both boys and girls, while for the control group the digital pattern is reversed or there is no difference between the two fingers. Therefore, we consider that the digital ratio biomarker (D2:D4) may be an additional useful criterion for the psychopedagogical diagnosis of ADHD or at least as a screening method.

Clinical pharmacist evaluation of medication inappropriateness in a geriatric hospital.

BACKGROUND: Potentially inappropriate prescribing (PIP) in elderly patients is highly prevalent and is associated with an increased risk of adverse drug events, morbidity, and mortality. Accordingly, this study aimed to evaluate the PIP encountered in a geriatric setting and to highlight the role of the clinical pharmacists in this context. METHOD: A retrospective observational study was conducted during March and April 2018 in an elderly daycare in Beirut area. Patients' files were screened to evaluate each patient's clinical status using a developed tool that included the Medication Appropriateness Index. Statistical analysis was performed using SPSS (version 20). The results were considered significant at P<0.05. RESULTS: The results showed a high incidence of hypertension, schizophrenia, and diabetes among the studied sample with percentages of 41.7%, 35.3%, and 26.6%, respectively. As for the PIP, drug therapy duration and cost were the most encountered problems followed by medication indication, dosage, and drug-drug interaction. Moreover, PIP increased with the number of prescribed medications (P<0.05). Proton pump inhibitors, low dose aspirin, and antidiabetic medications' users had a significantly higher Medication Appropriateness Index score as compared to non-users. CONCLUSION: As a conclusion, suboptimal care is proved in this study empowering the collaboration between clinical pharmacists and physicians in minimizing the PIPs in elderly daycares.

Acide hyaluronique intra articulaire dans la gonarthrose: une étude long-terme, ouverte, de Phase IV, avec analyse détaillée par stade de Kellgren-Lawrence.

INTRODUCTION: Les injections intra articulaires (IA) d'acide hyaluronique (HA) désignées sous le nom de viscosupplémentation (VS), sont fréquemment utilisées dans le traitement symptomatique de la gonarthrose (OA), une affection ostéo-articulaire chronique douloureuse et handicapante, qui touche une fraction importante de la population âgée. La sévérité de la gonarthrose est en général décrite par la classification en stades radiologiques de Kellgren-Lawrence (KL). La VS a été largement étudiée à travers de nombreux essais cliniques; cependant, les résultats sont rarement analysés en détail, en fonction du stade KL. MÉTHODE: Une étude ouverte importante, portant sur 1 177 patients souffrant de gonarthrose, fut réalisée de 2004 à 2007. Chaque patient a reçu un traitement de VS consistant en 3 injections d'ARTHRUM H 2% (LCA Pharmaceutical, Chartres, France). A l'inclusion, les patients ont été décrits par leur profil démographique, leur indice de masse corporelle (IMC), leur stade KL et leur état clinique selon les sous-scores douleur et fonction de l'indice Western Ontario and McMaster Universities (WOMAC). Les visites de suivi étaient à M3, M6 et M9 (mois) après la VS. Cette large base de données a été entièrement retraitée en 2019, de manière à fournir une analyse séparée par stade KL, et fut complétée par l'évaluation des taux de patients répondeurs (%) au traitement, selon l'Outcome Measures in Rheumatoid Arthritis Clinical Trials & Osteoarthritis Research Society International (OMERACT-OARSI). L'analyse fut menée à la fois sur les populations en intention de traiter (ITT) et per protocole (PP) ayant terminé l'étude. RÉSULTATS: En analyse ITT du critère principal, les variations du sous-score WOMAC A (douleur) depuis l'inclusion jusqu'à la fin de l'étude, ont été respectivement de 19,8 ; 19,8 ; 17,8 et 14,2, sur une échelle de 0-100, pour les patients des stades KL I à KL IV. En analyse PP dans les mêmes conditions, ces variations ont été de 20,6 ; 19,9 ; 17,1 et 11,7. Tous ces résultats étaient significatifs par rapport aux valeurs à l'inclusion (p<0.001) et cliniquement pertinents à chaque stade KL. Des améliorations significatives ont été également observées pour le sous-score WOMAC C (fonction), et pour les autres critères secondaires. Le taux de répondeurs OMERACT-OARSI variait de 72 à 82% pour les patients KL I à III à M6 et M9. Pour les patients KL IV, le maximum atteint a été 47.7% à M6. Les autres paramètres tels que le sexe, l'IMC ou l'âge, ne furent pas identifiés comme des facteurs de pronostic pour la réponse à la VS. CONCLUSIONS: L'analyse détaillée par stade KL d'une large cohorte de patients suivis en ouvert, suggère le traitement de VS avec ARTHRUM H 2% est applicable à une grande variété de patients gonarthrosiques.

Gastroprotective activity of Loranthus acaciae flower extract in a rodent model of ethanol-induced ulcer.

Loranthus acaciae (Loranthaceae) is a perennial green semi-parasitic plant used in ethnopharmacological medicine for healing wounds. The protective effect of L. acaciae on gastric ulcer induced by ethanol was investigated in a rat model. Ulcer index and total glutathione level were measured and histological and immunohistochemical studies for the expression of cyclooxygenase-2 were performed. Furthermore, chemical constituents of the flower extract were analyzed. Ulcer index was significantly lowered in L. acaciae-treated groups. Protection ratios were 75.9%, 98.9%, and 70.7% for 250 mg/kg and 500 mg/kg of L. acaciae and 40 mg/kg of esomeprazole, respectively. Histological examination revealed fewer hemorrhage in mucosa and less edema in submucosa of L. acaciae-treated groups compared with control. In the esomeprazole-treated group, there was mild disruption in the surface epithelium and mild hemorrhage. However, edema and leucocytes infiltration in the submucosa layer were present. Immunohistochemical staining of stomach sections for cyclooxygenase-2 (COX-2) was negative in the control group as well as in the L. acaciae-treated groups. Total glutathione level in mucosa layer of the stomach was higher in L. acaciae-treated groups compared with control. Liquid chromatography-mass spectrometric analysis revealed the presence of loranthin and rutin as the major constituents. It can be concluded that L. acaciae imparted a gastroprotective action against ethanol-induced ulcer in rats. Novelty 500 mg/kg L. acaciae protected the stomach by 98.9% from ulcerogenic effect of ethanol. L. acaciae increased total glutathione level but not COX-2 expression in gastric mucosa. Loranthin and rutin were the major constituents in L. acaciae flower extract.

[Obstructive Sleep Apnea Syndrome]. / Obstruktives Schlafapnoe-Syndrom.

Obstructive Sleep Apnea Syndrome Abstract. The obstructive sleep apnea syndrome (OSAS) is a disorder of the control of breathing in which repetitive collapse of the upper airway during sleep leads to frequent apneas/hypopneas with cyclic oxygen desaturation and arousals. Sleep is fragmented and unrefreshing. The affected patients suffer from an increased tendency to fall asleep, impaired concentration and a reduced quality of life. The consequences of OSAS also include an increased risk of accidents caused by falling asleep as well as cardiovascular diseases. The diagnosis of OSAS is based on a typical history and clinical examination. Overweight, a large neck circumference and a narrow throat are conditions that may suggest an OSAS. The diagnosis is confirmed by sleep examination. The most important treatment for OSAS is the nightly application of continuous positive pressure (CPAP) via a nasal or mouth-nose mask, which usually leads to a rapid improvement of the symptoms. Patients who do not tolerate CPAP therapy can be successfully treated with a mandibular advancement device. Supporting measures are regular and sufficiently long sleeping times, avoidance of smoking and alcohol consumption in the evening as well as weight reduction for obese patients.

Dietary inflammatory index and odds of colorectal cancer in a case-control study from Jordan.

Dietary components that promote inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet and CRC has been investigated in several developed or Western countries. Despite the fact that dietary choices in the Middle East differ markedly from those in the West, results have not been reported from any study conducted in a Middle-Eastern population. We examined the association between dietary inflammatory index (DII) scores and CRC in a case-control study conducted in Jordan. This study included 153 histopathologically confirmed CRC cases and 202 disease-free control subjects' frequency matched on age, sex, and occupation. Data were collected between January 2010 and December 2012, using interviewer-administered questionnaires. DII scores were computed from dietary data reported using a food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, sex, education, physical activity, body mass index, smoking, and family history of CRC. Subjects with higher DII scores were at increased odds of CRC, with the DII being used both as a continuous variable (ORcontinuous = 1.45, 95% CI: 1.13-1.85; 1-unit increase corresponding to ≈20% of its range in the current study) and as a categorical variable (ORtertile 3 vs tertile 1 = 2.13, 95%CI: 1.23-3.72). Our results, based on a Jordanian population, add to the growing literature indicating that a pro-inflammatory diet is associated with increased odds of CRC.

Validity of segmental bioelectrical impedance analysis for estimating fat-free mass in children including overweight individuals.

This study examined the validity of segmental bioelectrical impedance (BI) analysis for predicting the fat-free masses (FFMs) of whole-body and body segments in children including overweight individuals. The FFM and impedance (Z) values of arms, trunk, legs, and whole body were determined using a dual-energy X-ray absorptiometry and segmental BI analyses, respectively, in 149 boys and girls aged 6 to 12 years, who were divided into model-development (n = 74), cross-validation (n = 35), and overweight (n = 40) groups. Simple regression analysis was applied to (length)2/Z (BI index) for each of the whole-body and 3 segments to develop the prediction equations of the measured FFM of the related body part. In the model-development group, the BI index of each of the 3 segments and whole body was significantly correlated to the measured FFM (R2 = 0.867-0.932, standard error of estimation = 0.18-1.44 kg (5.9%-8.7%)). There was no significant difference between the measured and predicted FFM values without systematic error. The application of each equation derived in the model-development group to the cross-validation and overweight groups did not produce significant differences between the measured and predicted FFM values and systematic errors, with an exception that the arm FFM in the overweight group was overestimated. Segmental bioelectrical impedance analysis is useful for predicting the FFM of each of whole-body and body segments in children including overweight individuals, although the application for estimating arm FFM in overweight individuals requires a certain modification.

Short-term high-fat diet alters postprandial glucose metabolism and circulating vascular cell adhesion molecule-1 in healthy males.

Short-term intake of a high-fat diet aggravates postprandial glucose metabolism; however, the dose-response relationship has not been investigated. We hypothesized that short-term intake of a eucaloric low-carbohydrate/high-fat diet (LCHF) would aggravate postprandial glucose metabolism and circulating adhesion molecules in healthy males. Seven healthy young males (mean ± SE; age: 26 ± 1 years) consumed either a eucaloric control diet (C, approximately 25% fats), a eucaloric intermediate-carbohydrate/intermediate-fat diet (ICIF, approximately 50% fats), or an LCHF (approximately 70% fats) for 3 days. An oral meal tolerance test (MTT) was performed after the 3-day dietary intervention. The concentrations of plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), intercellular adhesion molecule-1, and vascular cell adhesion molecule-1 (VCAM-1) were determined at rest and during MTT. The incremental area under the curve (iAUC) of plasma glucose concentration during MTT was significantly higher in LCHF than in C (P = 0.009). The first-phase insulin secretion indexes were significantly lower in LCHF than in C (P = 0.04). Moreover, the iAUC of GLP-1 and VCAM-1 concentrations was significantly higher in LCHF than in C (P = 0.014 and P = 0.04, respectively). The metabolites from ICIF and C were not significantly different. In conclusion, short-term intake of eucaloric diet containing a high percentage of fats in healthy males excessively increased postprandial glucose and VCAM-1 concentrations and attenuated first-phase insulin release.

The Visceral Adiposity Index in Comparison with Easily Measurable Anthropometric Markers Did Not Improve Prediction of Diabetes.

OBJECTIVES: We evaluated the ability of the visceral adiposity index (VAI) compared to hypertriglyceridemic-waist (HTGW) phenotype, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) as a possible predictor of diabetes in a nondiabetic high-risk population. METHODS: We analyzed 7-year follow-up data in nondiabetic first-degree relatives of consecutive patients 30 to 70 years of age with type 2 diabetes and with at least 1 follow-up examination (N=1720). The primary outcome was the diagnosis of type 2 diabetes based on repeated oral glucose tolerance tests. We examined the incidence of type 2 diabetes across quintiles of the VAI and plotted a receiver operating characteristic (ROC) curve to compare the abilities of predicting type 2 diabetes of the VAI, BMI, WC, WHR and WHtR. RESULTS: The highest quintile of VAI compared with the lowest quintile was associated with type 2 diabetes in age- and gender-adjusted models (OR 2.45; 95% CI 1.56, 3.86). Those with the HTGW phenotype were 2.36 times (OR 2.36; 95% CI: 161, 3.44) more likely to develop type 2 diabetes than those with normal WCs and normal triglyceride levels. On ROC curve analysis, almost similar areas under the ROC were found for BMIs (60.9%; 95% CI: 57.1, 64.6); WC (61.0%, 95% CI 57.4, 64.5); WHtR (62.6%; 95% CI: 59.1, 66.2); WHR (55.7%; 95% CI 52.2, 59.3) and VAI (58.3%; 95% CI: 54.5, 62.1). CONCLUSIONS: These data provide further evidence that VAI and HTGW are robust predictors of type 2 diabetes, but the predictive power was similar to that of BMI, WC, WHtR and WHR in our study population.

Examining differences in nutrient intake and dietary quality on weekdays versus weekend days in Canada.

This study examined differences in dietary intake on weekdays versus weekends in Canada (n = 34,402) and found that energy intake was 62 ± 23 kcal higher, and dietary quality was slightly lower on weekends (p < 0.05). After energy adjustment, Canadians consumed 66% more alcohol, 10% more cholesterol, and significantly lower intakes of carbohydrates, protein, and most micronutrients (ranging from 2.0%-6.9% lower) on weekends. Findings suggest that Canadians consume a slightly less favourable nutrient profile and poorer dietary quality on weekends.

Anthropometric indices predicting incident type 2 diabetes in an Iranian population: the Isfahan Cohort Study.

BACKGROUND: The link between adiposity and type 2 diabetes (T2D) is well known. However, it remains controversial as to which index and cutoff point is the best predictor in different populations. METHODS: A total of 2981 urban and rural Iranian adults over 35 years of age, and free of cardiovascular disease and diabetes were followed for 7 years. Anthropometric indices included body mass index (BMI), body adiposity index [BAI=(hip circumference/height¹·5)-18], waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR), and waist and hip circumferences. T2D was defined as fasting plasma glucose ≥ 126 mg/dL or 2-h post-prandial plasma glucose ≥ 200 mg/dL, or the use of antidiabetic agents. Receiver operating characteristic curve analysis determined the best cutoff point for each adiposity index. RESULTS: After 7 years of follow-up, 389 new cases of diabetes were found. Most indices were linearly associated with increased risk of diabetes but the best continuous predictor was WHtR in men [odds ratio: 1.10 (95% confidence interval: 1.07-1.12) for one unit] and BMI in women [1.08 (1.04-1.11) for 0.1 kg/m²]. BMI cutoffs of 26 kg/m² in men and 30 kg/m² in women were the best binary predictors in adjusted models, and showed increased T2D risks of 2.91 (2.06-4.12) and 1.94 (1.42-2.66) times, respectively. All central-obesity indices in men and WHpR in women were also significantly associated with T2D independent of BMI. BAI was significantly associated with T2D in men but not in women. CONCLUSION: BMI at the appropriate cutoffs in both genders and WHtR in men and BMI in women as continuous factors were the best predictors of incident T2D in this Iranian population.